by Diana Batoon DMD
Maybe you have the next Steve Jobs, Lebron James, or Malala Yousafzai in your practice and they are 8 years old. Yet they have asthma, crooked teeth, and a bed-wetting problem. What’s a dentist to do? 20 years ago, we were focused on prep depth, line angles and shade-matching porcelain. Dentistry has changed; our duty is no longer limited to correcting teeth – it has expanded to correcting the airways of our patients. We are facing a major dilemma: If the majority of dentists do not become aware of silent epidemic of Sleep Disordered Breathing occurring in children, the future of successful entrepreneurs, phenomenal athletes, and inspiring leaders may never be fully realized. We have a tremendous opportunity to improve breathing, improve futures, and improve society.
Sleep Disordered Breathing (SDB) in children is widespread but most parents do not see the signs. They need to learn what to look for. What is our role? Our teams can talk about it to our patients. We can provide user-friendly literature on the topic and offer easy preventive solutions. Why don’t most dentists take this critical step? Frankly, we get complacent doing what we’ve always done: Basic dentistry. Treating decay is something we are really good at diagnosing and treating. It’s time to shift our focus to the overall health of our patient population and increase awareness…starting within the walls of our own practice.
I will be the first to admit that I was not great about watching my children sleep. Before I learned much about the problems, in my dental practice I hardly ever asked a parent “How does your child sleep?” Then I read medical research on how mouth breathing, snoring and hyperactivity are directly linked to lack of quality sleep. I learned that kids with breathing disorders are all around us, probably including someone you know. It might have been the now-29-year-old that went through orthodontics twice, had her tonsils and adenoids removed, and was a frequent patient at the pediatrician’s office with ear infections, strep throat or bad allergies. Remember when Johnny had a bed-wetting issue at age 9 and missed out on sleep overs or summer camp for fear of embarrassment? These are actually patients in my practice who never brought up these episodes because I didn’t know to ask. In my practice, a sleep questionnaire is now part of the new patient intake forms. Implementing a dialog with your patients is the easiest and most important first step you can take.
Active growth in children provides an opportunity to correct a retrognathic mandible or to expand the maxilla. We can start by using a habit corrector and myo-functional therapy to ensure tongue placement is correct and a proper swallow develops. If need be, a RPE or Schwarz appliance may be a suitable option. Either way, we are evaluating for outward signs that may belie a restricted airway or poor tongue habits. Crooked teeth get straighter, yes, but that’s a nice benefit, not a primary goal!
Children with behavioral and physical differences often have treatment plans that focus more on their disability instead of their ability. Society slaps them with labels and compartmentalizes them in sub-categories that come with social stigmas. Their journey among all the appointments with doctors, speech therapists and other specialists are too often focused on what is “wrong” rather than what is “right”. While peers may accept their difference, carrying the burden of being different is challenging. Many parents seek a quick-fix…especially when their child is suffering physically or emotionally. It takes time to identify and treat the root cause, but it is worth it. Preventing and correcting sleep disordered breathing could save countless children from being misdiagnosed and mislabeled, especially for social challenges. Our committment to identifying and addressing the root cause may prevent much of the overmedication and lost opportunities found today in children.
Parents may not know how damaging mouth breathing can be. Noticing behavioral problems such as elevated anxiety or GI upset, many families resort to changing their diets to eliminate dairy, wheat or gluten to seek relief from their symptoms. SDB due to a restricted airway or lack of nasal breathing can cause a lack of oxygen to the brain during REM sleep that leads to improper amounts of hormones released by the pituitary gland. This is especially true for children that may have short stature. When mouth breathing changes to nasal breathing, these children exhibit a growth spurt and the development of the brain is maximized.
Every child should sleep soundly and breathe properly. Could it be possible that the child with ADD/ADHD actually is not? What if their symptoms were a direct result of poor diet, poor sleep and improper tongue-position? Mouth-breathing causes adverse effects on the immune system and endocrine system. I have an 9-year-old patient in my practice who suffers from allergies and asthma. When we corrected his mouth-breathing while he was sleeping and he became a nasal breather, his eczema improved drastically and his daily dependency on an anti-histamine has been eliminated.
There is an increasing number of adults who suffer from sleep apnea. The question is: Did their condition appear in adulthood or was it overlooked in childhood? As adults, their choices to managing their condition are lifetime use of a CPAP or an oral appliance, with surgery and weight loss being less often chosen. We can easily rescue people from this sad destiny. All parents must be encouraged to start observing their children’s sleep to ensure nasal breathing, even as infants. For many years now, lactaction specialists have identified that tongue-tied or lip-tied infants are unable to latch or nurse properly. Once these hindrances are solved, proper and effective nursing can ensue. In the last year, I have done more tongue-releases than I did in the previous 20 years! I have found that many of these children had difficulty nursing or were babies who were bottle-fed. In every hygiene check and every comprehensive exam, the airway is addressed. When we examine a child who predominately mouth breathes and has a tongue-tie, we discuss the benefits of frenectomy.
Changing team systems is hard – but we’ve started paying attention to neck circumference because of a sleep apnea course we took. We have our sleep apnea patients do things that are unusual for a dentist to ask for; we give them devices that create small problems. In fact, sleep apnea patients may feel worse before they feel better. The main point is we are helping them to breathe better, maximize the oxygen flow to their lungs, and in turn… stay alive. For many patients, treating their apnea is life-changing. We are proud of our clinical dentistry but we don’t save lives with it. Helping a child sleep soundly, breathe better and develop into a thriving individual is undoubtedly life-changing – for them, for the parents, and for us, too. Maybe one of our young patients will grow up to change the world. Maybe one of yours will.
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